Provider Demographics
NPI:1326054776
Name:REBONG, KENNETH POMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:POMAR
Last Name:REBONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2350 MCKEE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1617
Mailing Address - Country:US
Mailing Address - Phone:408-729-3232
Mailing Address - Fax:408-729-2165
Practice Address - Street 1:2350 MCKEE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1617
Practice Address - Country:US
Practice Address - Phone:408-729-3232
Practice Address - Fax:408-729-2165
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-04-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA458132080A0000X
CAA045813208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine